July 25, 2009

The Funny Thing Is, Obama Could Easily Have a Health Care Bill, If...

...If he really just wanted a bill -- as opposed to this bill, the Pelosi bill.

I know this is a crazy idea that nobody would ever even consider; no Democratic president would ever, ever consider triangulating between the three main congressional sects. But if Barack H. Obama were simply to reach across the aisle not only to the Blue Dogs but even to the Republicans (eeeeeeeeeeeee!), and offer an actual compromise, he would almost certainly get a third to a half of the liberals as well (they would be getting something they wanted -- say, more government help for low-income Americans to buy health insurance -- and they're predisposed to support the Obamacle anyway).

Something like:

No "government option;"

Mandated medical insurance (using the jiggery pokery of withholding some portion of federal Medicare payments to states that don't have some form of insurance requirement and enforcement, since the feds cannot directly order the little people to buy insurance, I wouldn't think);

Assistance to low-income Americans -- say, up to 150% or 200% of the poverty line -- to buy private or group insurance;

Looser rules for group insurance, to allow more creative "groups" for insurance consumers, beyond the usual group=employees model;

Expanding the size of an MSA that can be deducted from income tax, and allowing individuals to deduct all of their health-insurance premiums, if they itemize;

Shifting Medicare and Medicaid from defined benefit to defined contribution -- where the contribution from the feds is to pay some portion of a group insurance premium -- with the particular plan to be chosen by the Medicare/Medicaid recipient from a list of eligible plans. Recipients could choose the cheapest plan and pay some small portion of it; or they could pick a more expensive plan with better coverage, and pay a larger portion. The feds would pay the same amount no matter what plan is chosen; if a recipient wants more, he can pay for it.

Allowing insurance companies to sell to anyone in any state (that the feds can certainly do; it's obviously related to interstate commerce);

Requiring insurance companies that sell across state lines to accept people with preexisting conditions at about the same rates as everyone else, or a little higher, using the same model as allotting bad drivers among different automobile insurance companies as "assigned risks;"

Maybe one or two other things to drag in this or that group.

If Obama really, really wants a bill, this would do it: He would get most of the Republicans, all of the Blue Dogs, and a third or more of the liberals who don't want to destroy their own president; that adds up to a minimum of 230 in the House and at least 55 in the Senate, in both cases likely more. The die-hards on both Left and Right could vote against it to satisfy their constituents, but it would still pass... and I doubt the Left could scrape together 41 senators willing to shoot down such a clear compromise via filibuster, and risk more voter wrath.

So the question is this... Which is more important to you, Mr. One We Have Been Waiting For -- getting some forward momentum towards resolving the problem of 46.7 million uninsured Americans (most of whom can afford insurance, they just don't want to); or gobbling one seventh of the nation's economy into the belly of the bureaucratic beast?

The first option, the blue pill, is almost risk-free, and will give a huge boost to your approval rating. The second option -- red pill -- is very, very risky, could end in a complete debacle that would (as you yourself said) destroy your presidency... and would almost certainly look like a really, really, really bad deal in three years, with many Americans already losing the health insurance they liked, just as you're running for a return engagement at la Casa Blanca. Which bitter pill would you swallow, blue or red?

I predict that when it becomes clear that Congress is simply not going to enact Emanuel's Folly, sometime in September, Obama will suddenly turn into a triangulating pragmatist... and we'll see a compromise health-care bill along the lines of the outline above.

Hatched by Dafydd on this day, July 25, 2009, at the time of 12:45 AM

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Are you really saying that we should allow the rich to use their ill-gotten gains to purchase better health coverage? Next you’ll say they should be entitled to buy better houses, better cars -- even better food and drink! How can you suggest such a thing?

Say, if there’s room for doubt about that question, how can I sign up for your health plan?!

The above hissed in response by: Dick E at July 25, 2009 8:40 PM

The following hissed in response by: MikeR

I agree with you, Dafydd, but I'm not sure President Obama will. He's pretty set on the "real fix", from his lights, and anything that doesn't look like the European systems may not do it.

As long as we're designing this "dream plan", by the way, would you consent to stop requiring emergency rooms to treat everyone? You're providing mandatory coverage to everyone anyhow; they are all able to get treated. And of course they would continue to treat all true emergency cases. Have emergency rooms direct non-emergency cases to get insurance and use it. This is about the only feature of American health care that I can't really understand why anyone would support. And some hospitals have stopped having emergency rooms for this reason.

I haven't thought much about it. You'd have to allow an initial diagnosis even to discover whether it's a true emergency; at which point, in many cases, treatment is fairly easy -- even in non-emergency cases.

It might be a better idea to make it easier to collect from deadbeats who aren't completely broke... but what do you do about, e.g., the bum on the street who has one toxic alcohol overdose after another? He literally has nothing, not a dime... he's usually too out of it even to beg. I'm not sure what can be done about such people, other than continue to pay for their ER visits until they do us all a favor and die.

Dunno, Dafydd. I've worked in an emergency room. Emergency rooms can be busy places, and initial triage can get done pretty quickly, within seconds of arrival, and not necessarily by The Big Doctor there. They have specialized equipment and training. They would look very different if they routinely told patients that We don't do that; you can wait till tomorrow morning and go to a doctor. Or, We have some free time now, so we'll treat you if you want, but only if you pay us (which is a lot more than a regular doctor's visit).
In general I don't like that so many doctors just send their patients to emergency rooms if it's not 9 to 5. My father, may he rest in peace, used to make house calls. And if not that, the doctor should be able to make some level of triage over the phone and tell the patient if it can safely wait till morning.

I remember that this was a point Mitt Romney made during his campaign. One may dislike various aspects of Massachusetts health care, but surely this point is clear - it doesn't make sense to let people use emergency rooms as their primary health care facility. If we're paying for it anyhow, let's find them somewhere else to go.

The above hissed in response by: MikeR at July 27, 2009 5:55 AM

The following hissed in response by: Geoman

Throw in some tort reform icing on the cake. Perhaps that you are only able to sue based on what you paid - if you didn't pay for health care, you have limited rights to sue over the quality. Also expand the good Samaritan laws to include emergency care situations - crash sites, ambulances, emergency rooms, etc.

Also- everyone pays something. Even if the feds have to garnish your wages or social security. Everyone pays something. $10, $20, whatever. No free health care for anyone. The emergency room should be more expensive than the regular doctor.

The above hissed in response by: Geoman at July 27, 2009 11:10 AM

The following hissed in response by: luagha

If the goal was actually to have a better healthcare system, all of your ideas would be wonderful for President Obama.

But that's not the goal.

The goal is to move more of the economy under state control and give the government the power of life and death.

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